Setting a practice budget and checking it monthly

How a practice sets a budget per account for the year, compares it with ledger actuals each month, and treats purchase orders as committed spend.

By Achekam · 11 October 2026 · 4 min read · For Healthcare businesses in South Africa, Nigeria, Kenya

At the first partners' meeting of the year, someone asks whether the practice can afford a second hygienist, a new autoclave and a fee review all at once. Someone else has a spreadsheet budget from last year that nobody has opened since March. The conversation runs on impressions: it feels busy, the bank balance looks fine, the consumables bill seems high.

A budget kept in the books changes that conversation. Each month, the partners see what the practice planned to spend and earn, account by account, beside what actually happened. This article covers building the budget, entering it in Achekam, reading the comparison and using purchase orders to see spending before the invoices arrive.

Build the budget from last year's accounts

Start from what the practice actually did. Management accounts show an income statement for any chosen period beside the period before, added up from the practice's own journals, and they export as PDF or CSV. Export last year's figures month by month and use them as the base.

Then adjust each line for what you already know about the year ahead:

• Income. Consultation and procedure fees, any planned fee review, a new associate starting mid-year, a partner reducing hours.
• People. Salaries, locum cover for leave, the new hygienist if the partners approve her.
• Clinical consumables. Gloves, dressings, materials and dispensary stock, which tend to follow patient volumes.
• Premises and equipment. Rent and escalations, maintenance contracts, the autoclave if it is bought.
• Everything else. Professional fees, insurance, software, training.

Budget by month, not just for the year. A practice's year has a rhythm: the December slowdown, the winter rush, the month when the annual insurance premium falls due. A monthly budget that follows that rhythm makes the comparison meaningful; a year divided evenly by twelve makes every quiet month look like a crisis.

Enter budgets per account and period

A business can set a budget per account and period in Achekam and compare it with actual figures from its ledger. Because the budget is held against the same accounts the practice posts to, the comparison needs no re-keying.

That makes the chart of accounts the frame for the budget. Accounts can be added, renamed or switched off, so tidy the chart first. If the partners want to see laboratory fees apart from other clinical costs, give them their own account before entering budgets, not afterwards.

One limit for Nigerian and Kenyan practices: at the time of writing, the ledger screens show every amount in rand, and the chart of accounts is stored in ZAR, even for a Nigerian or Kenyan business. Enter and read your figures as the naira or shilling amounts you post, and keep that in mind when you export.

Comparing with actual figures from the ledger

Actual figures come straight from the ledger, so the comparison is only as current as the bookkeeping. Before the monthly review, make sure the month is complete: supplier bills captured, scheme and patient receipts recorded, the bank reconciled.

Months can be soft-closed, hard-closed and locked, and a closed month refuses postings from every source. Before closing, the screen checks that the ledger balances and that no posting suggestions, unposted bills or unmatched bank lines are waiting. Closing the month before the review means the figures the partners discuss will not move afterwards.

When you use the management accounts for a year-to-date view, note that the year-to-date preset starts on 1 January, not on your own financial year start. If the practice's year starts elsewhere, choose the period yourself.

Purchase orders as committed spend

A budget that only looks at invoices already received is always a month late. Purchase orders close that gap.

Staff raise a purchase requisition saying what is needed, why and the estimated cost, and someone other than the requester approves or declines it. A purchase order is then raised from the selected quotation, and the person who raised it cannot approve it. Once approved, purchase orders count as committed spend against budgets per expense account and period. The screen shows budget, spent, committed and available for each line, and flags over-committed lines without blocking a purchase.

A worked example in words: the practice budgets for clinical consumables each month. In the middle of the month, the practice manager raises a large order of dressings and gloves ahead of the winter rush. Once a partner approves it, the order shows as committed against the consumables budget, and the line is flagged as over-committed for the month. Nothing is blocked; the partners simply see, before the supplier's invoice arrives, that consumables will be over budget, and can decide whether the bulk purchase was worth it.

A monthly review routine for the partners

Keep the review short and regular:

1. Close the month once bills, receipts and the bank are complete.
2. Read income first. Is the practice billing and collecting what it planned?
3. Look at the largest variances, not every line. Ask why, not who.
4. Check committed spend against what is left in each budget line.
5. Decide actions, such as delaying a purchase, reviewing a supplier or revisiting fees.
6. Note anything that changes the rest of the year, and reforecast if the change is lasting.

Partners who want more than a budget pack can borrow from how other professions report; management accounts for partners shows a consulting firm's version, and grant budget against actual shows the discipline when every line is answerable to a funder. ACCA's article all about budgeting explains flexible budgeting and how fixed and variable costs are used to budget across activity levels, which suits a practice whose consumables rise and fall with patient numbers.

A budget earns its keep in the monthly meeting, not in January. Build it from last year's accounts, hold it against the same ledger accounts, and let committed spend warn the partners before the invoices do.

General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.